DFS pledges to investigate insurers’ contraception coverage (updated)

The state Department of Financial Services said Tuesday it will investigate whether New York health insurers are complying with statutory contraceptive coverage requirements.

DFS is conducting the investigation after its undercover sting of 15 unnamed insurers, according to a release. The sting identified 11 insurers that allegedly provided consumers with incorrect information about contraceptive coverage. DFS claims some insurers are incorrectly telling callers that consumers must pay for contraceptive drugs and devices, though state law and the Affordable Care Act mandate that they be covered without co-payments, deductibles or out-of-pocket costs.

DFS did not respond to an inquiry about which 11 health insurers have run afoul of the law.

DFS plans to request that non-complying insurers develop a corrective action plan and that they provide information and documentation regarding their coverage and reimbursement of contraception, specifically whether claims were paid out without cost-sharing being imposed.

Capitalizing on the Women’s Marches last month, Gov. Andrew Cuomo announced regulatory actions to ensure that contraception is covered by commercial health insurance policies without co-pays or deductibles, regardless of if the ACA is scrapped or re-worked. A requirement that medically necessary abortions are covered by commercial health insurance policies — except for high deductible plans — without co-pays, coinsurance or deductibles also was imposed.

“Any insurer that is not providing full and accurate information about coverage requirements will be met with swift action to ensure full compliance with this important coverage protection,”DFS Superintendent Maria Vullo said in a statement. “DFS’s undercover sting identified insurers that provided inaccurate information about contraceptive coverage, and DFS will ensure that all New Yorkers have full access to reproductive health care as mandated by New York law.”

Update: New York Health Plan Association President and CEO Paul Macielak took issue with the DFS’ “sting” operation:

Health plans make every effort to provide consumers with accurate and up to date information.

In the case of contraceptive coverage, the FDA has identified 18 different methods, with many of those having multiple forms. New York and federal law require plans to provide coverage ‘at least one form of contraception in each of the FDA-approved contraceptive delivery methods without co-pays, coinsurance or deductibles.’ This amount of variation opens the door for miscommunications and possible errors during a complex transfer of information.

We do not believe that a series of a few calls to plans’ member services departments constitutes an ‘undercover sting’ investigation, as characterized by the Department of Financial Services, and feel this is simply old news because the Department already issued a Circular Letter clarifying contraceptive coverage rules prior to this report.

Health plans are prepared to work with the Department in constructive efforts to ensure New York consumers get all the information they need to make decisions about their coverage.